Closing Arguments-The Day of Reckoning
President Obama making the final arguments for Health Reform
My Saturday began on the West lawn of Capitol Hill, where conservative activists were mounting one final, desperate effort to block health care reform. They came by the thousands, carrying flags and pushing strollers, in a demonstration of genuine grassroots fervor. They chanted “Kill the Bill,” over and over again, in a vaguely menacing tone that, perhaps, foretold a bit of ugliness to come.
But the most remarkable thing about the demonstration was how little it had to do with health care. The signs said “Stop socialism,” “A government of laws, not men,” “Respect our constitution–preserve our republic.” Nobody talked about death panels. Instead, one speaker–a Chicago radio host, I believe–attacked the First Lady’s obesity initiative. “Michelle, keep your hands off my kids’ lunchbox!” Yet another protest sign seemed to capture the mood perfectly: “This isn’t about health care. This is about control.”
A few hours later, inside the Capitol complex, President Obama urged House Democrats to do precisely what the protesters feared: Pass health care reform. It was not the first time he’d given such a speech. Just before the House voted on its initial reform bill in November, he’d come to Capitol Hill. And, broadly speaking, his intent had been the same: To embolden the Democrats by making them enthusiastic about the cause, demonstrating his own commitment to it, and making clear the political virtues of success.
But, like the protesters, this time Obama seemed to dwell less on health care and more on the significance of the moment. He invoked Lincoln, and the importance of fighting for principle. And then he invoked the legacy of the New Deal and Great Society, reminding members that their purpose in office was not to win elections–it was to make life better for their constituents. His closing argument was not about policy or politics. It was about posterity. And it was good.
For the last week or so, ever since it’s become apparent a climactic vote on health care was approaching, I’ve also been thinking about closing arguments. For most of the past year–and, really, it’s been far more than a year–the argument has been most practical. What would the bill do? What wouldn’t it do? And it’s easy enough to make the case for reform on those grounds.
As readers of this space know, I like to think of reform as achieving three broad goals: Making sure anybody can get an affordable insurance policy, shoring up everybody’s coverage so that it provides real economic security, and transforming medical care in order to make it both more effective and less expensive. Those arguments got a lot stronger this week, when the Congressional Budget Office determined that the final reform package–including both the Senate’s health care bill and the proposed amendments to it–would provide coverage to 32 million additional people, strengthen the baseline for coverage, and reduce the federal deficit over time.
But there’s another argument for health care reform, one that is at once more subtle and more sweeping. The disturbing part of our health care system is the financial and physical suffering it causes. But the unjust part of our health care system is the way it distributes that suffering. There are things all of us can do to stay healthy–we can eat right, we can exercise, we can avoid excessive risks. But even when we do the right things, we remain vulnerable.
You can have the perfect diet, jog three miles every day, and wake up one morning to discover you have cancer. So now you face mortal peril. And if, on top of everything else, you can’t pay your medical bills, you face financial ruin, as well.
Chance, of course, is part of life. Americans, in particular, seem to accept that. But every now and then, we have decided that need for such expansion–that there was, even now, the kind of common vulnerability to chance that required the sorts of initiatives we had enacted in the past. It happened with the New Deal, when we created the modern welfare state, and then again with the Great Society, when we expanded it.
The signature programs of these eras, Social Security and Medicare, work because they address a vulnerability we all share. Everybody is at risk of getting old; and everybody is at risk of misfortune, physical and financial, when that happens. To protect against that misfortune–to insure against that misfortune–all of us contribute. We all give, in the form of financial contributions; and we all get, in the form of financial security. Together, quite literally, we are stronger than when we are apart.
The conservatives protesting on the Capitol lawn Saturday see things differently. Health care reform isn’t about contributing money for the sake of their own security; it’s about having their money taken for the sake of somebody else’s security. When they hear stories of people left bankrupt or sick because of uninsurance, they are more likely to see a lack of personal responsibility and virtue than a lack of good fortune. As my colleague Jonathan Chait has observed, theirs is an extreme version of a view common (although surely not universal) on the right: That individuals can fend for themselves, as long as they are responsible and as long as the government gets out of the way.
There’s obviously a balance to be struck between these two world views. But, broadly speaking, conservative ideas about responsibility and vulnerability have dominated political discussion for most of the last four decades. That will change on Sunday, if health care reform passes. The bill before Congress may be flawed. And the process that produced it may be severely flawed. But it is, nevertheless, an expression of the idea that we–as as society–are not prepared to let people continue to suffer such dire consequences just because they’re unlucky.
A few hours after Obama was speaking, the Capitol had nearly cleared out. Leadership staff were meeting in House Speaker Pelosi’s office while a few stray congressmen were giving floor speeches to a nearly empty chamber. By and large, though, members had scattered–a tell-tale sign that Pelosi was confident. If she’d still needed to do serious arm-twisting, she’d have held a series of votes to keep members on the Hill.
I walked the length of the building and then out to the east lawn where the conservative protesters, who spent the day visiting (and, on a few occasions, haranguing) House Democrats, had reconvened. The crowd was more subdued now. It was smaller, too–hundreds instead of thousands. The setting sun behind the capitol dome cast a long shadow over them, as night approached. But a new dawn would come soon enough. And with it, perhaps, a new era.
By: Jonathan Cohn-Senior Editor-The New Republic-March 21, 2010
What Failure Would Cost the Democrats-A Cold Analysis of This Weeks Vote
Disgruntled (if not former) Democrats Pat Caddell and Doug Schoen are the latest to join in offering advice to President Obama and Congressional Democrats to abandon their health reform quest before it causes catastrophic damage to the party. Caddell and Schoen close their Washington Post article with the following warning: “Unless the Democrats fundamentally change their approach, they will produce not just a march of folly but also run the risk of unmitigated disaster in November.”
The case Caddell and Schoen make parallels the one made the previous day by Karl Rove in the Wall Street Journal, and that is made daily by a parade of Republican pollsters and lawmakers: The Democrats’ health reform plan is wildly and deeply unpopular, mirroring the unpopularity of Washington and big government. If it passes, it will result in a huge political backlash, especially if Democrats use reconciliation, which Caddell and Schoen call manipulation and liken to the “nuclear option” that Senate Republicans threatened during the Bush administration. For Rove, the use of reconciliation will open the way for Republicans to use the same technique to repeal health plan when they recapture the majority.
We fundamentally disagree; the surest path to political debacle for Democrats is to fail to enact health reform, and the best way to avoid a rout in November is to show that the party in charge can actually govern. The reconciliation process is entirely appropriate for amending the Senate-passed bill; in any case, the public will judge the Democrats on the basis of the results, not the inside-baseball process. In fact, the Democrats most reluctant to support health reform–those from more conservative, Republican-leaning districts and states–are the ones most likely to lose in November if health reform is defeated.
The obvious first antecedent to examine is 1994. Democrats went into the midterm elections after a presidential contest in which they grasped the full reins of power in Washington for the first time in a dozen years. Early momentum disappeared when first President Bill Clinton’s modest stimulus proposal went down in the Senate and then his deficit-reduction package staggered to the finish line after eight long months and without a single Republican vote in either house. It looked more like a setback than a victory. This was followed the next year by a lengthy struggle to enact sweeping health care reform that ended in a complete collapse, without even a vote on the Clinton plan. A shocking loss in the House on a crime bill, though ultimately reversed, reinforced the image of a president and party that could not govern competently.
What followed was a disastrous midterm for Democrats—losses of 54 seats in the House and eight in the Senate. Heading into that election season, House Minority Whip Newt Gingrich, described the Democrats’ condition bluntly: “Imagine it’s October, and the Democrats are going to get up and make the following case: ‘We’ve run the House for 40 years, we’ve run the Senate for eight years, we have the White House, and the Republicans are so much more clever than we are that they’ve obstructed us. We need you to elect more dumb Democrats so we can overcome those clever Republicans.’” Conservative Democratic Senator John Breaux, of Louisiana, echoed that point on health policy, saying, “We can blame the Republicans for filibustering, but we have the responsibility to govern.”
To be sure, there were many reasons for Democrats’ massive losses in 1994, including scandals and angry gun owners. But the failure to fulfill their responsibility for governing contributed mightily to the debacle. That was the conclusion of pollsters from both parties in the aftermath of the November contests. Two weeks after the election, Republican pollster Bill McInturff found that “one of the most important predicates for Republican success was not having health care pass.” He noted that the collapse of the plan reinforced voters’ belief that Washington was in a dysfunctional state of gridlock. At the same time, Democratic pollster Mike Donilon, who worked on the losing campaign of Pennsylvania Senator Harris Wofford, said he believed that Wofford would have won had health reform passed.
It is undeniably true that a Washington plan to reform health care is not overwhelmingly popular. But that’s mostly because Washington is unpopular these days. When the component parts of the Democrats’ plan are parsed out, surveys show high approval for nearly all of them, including removing preexisting conditions, ending lifetime benefit caps, providing tax credits to small business to get them to cover employees, subsidizing low- and middle-income families to enable them to buy insurance, and creating a health-insurance exchange to shop for policies.
We also know that voters are warming somewhat to the idea of a reform plan, in part because the president has ramped up his efforts on its behalf beginning with the State of the Union and the health-reform summit—letting voters know what is actually in the bills. The actions of insurance companies like Anthem and Wellpoint, raising premiums sharply before enactment of reform, has also contributed to a public receptiveness to change. And we know that there was a noticeable bump in public approval when bills passed the House and the Senate—voters like action, and like success. Even where we are skeptical about the benefits of government programs, we want government to work.
It is also true that the health-reform plan, contrary to conventional wisdom, will not simply frontload the costs and backload the benefits. The plan will move quickly to erase the unpopular “doughnut hole” that results in a costly jolt for many seniors buying prescription drugs, to end discrimination based on preexisting conditions for children, to ease the insurance burden on those losing or leaving their jobs, and to enable parents to carry children up to the age of 26 on their family policies. Many House and Senate Democrats are understandably nervous about voting to enact health reform. We are convinced that the political damage will be far, far worse if they fail to do so.
By: Norman J. Ornstein and Thomas E. Mann. They are co-authors of The Broken Branch: How Congress is Failing America and How to Get It Back On Track. March 15, 2010-The New Republic
In Search of Plan “C” for Health Care Reform?….Stick With Plan “A”
The Washington Post has an editorial this morning that doesn’t exactly oppose the President’s health reform proposals, but gives the President a rap on the knuckles for not being more aggressive controlling costs. They are particularly aggrieved that the President proposes to delay the implementation of the “Cadillac tax” on high-cost health plans to 2018.
“Count us among the worriers. The tax is key for two reasons. It would raise revenue needed to pay subsidies to the currently uninsured; Mr. Obama chose the politically easier option of extending the Medicare tax to unearned income of the wealthy, thus making it more difficult down the road to prevent Medicare from going bankrupt. And, by discouraging expensive plans, such a tax would be the single most effective tool to reduce the cost growth that threatens the nation’s well-being”.
This editorial is one of the more exasperating documents to appear during health reform.
I happen to favor the “Cadillac tax,” though I wish it were more explicitly limited to affluent taxpayers. This is a sensitive issue. Workers have made wage concessions to expand or to preserve generous health benefits that might be affected by the new policy. I see nothing inherently wrong with giving unions and firms more time to adjust collective bargaining agreements in light of new tax policies.
Especially perverse is the Post’s criticism of proposals to raise Medicare taxes on the wealthy. Viewed outside the context of health reform, this provision provides one needed corrective to the regressive tax cuts enacted during the Bush years. The idea that it is simple political expediency to raise taxes on capital income of the wealthy comes as a great surprise to anyone who has followed American tax policy over (say) the past 30 years. Three other issues are especially irksome in the Post’s editorial.
First, President Obama proposes many features designed to reduce the level and growth of medical spending. He has gotten little political credit for these complex and controversial measures, but they are there.
Insurance exchanges will reduce administrative and marketing costs in the markets for individual and small-group coverage. This idea enjoys wide Democratic and Republican support. The President would reduce significant overpayments to Medicare advantage plans. He supports bundled payment models and other innovations designed to improve quality and cost-effectiveness of care. He supports greater use of comparative effectiveness research to provide an evidence-base for improved resource allocation decisions.
Over considerable opposition from within his own party, the President supports an Independent Medicare Advisory Board modeled after the commission that recommends military base closings. The Congressional Budget Office gave the President little credit for this in the scoring numbers. Yet this change could have a potentially revolutionary impact on Medicare policy–which is exactly why so many pharmaceutical and medical device manufacturers, many medical specialties, and many elected politicians are unhappy with this measure.
Some of these measures are buried in the fine print. Others were included despite deep opposition from self-avowed fiscal conservatives whose concern for the federal budget precisely stops at the boundaries of their own states or their own favored constituencies. (The most powerful cost-control measure, a strong public option, was brought down by Republicans, insurers, and virtually the entire supply-side of the medical economy, but that is another story.)
These obvious realities underscore the second reason why the Post’s argument is so irksome. Although the House and Senate bills include many specific elements favored by (for example) officials in the last Bush administration, Republicans have made a basic strategic decision to filibuster and to vote in lockstep against the signature policy initiative of the Obama Presidency.
As a result, President Obama needed to corral every single Democratic vote to pass the signature measure of his presidency. The President was willing to deal on tort reform and other difficult matters. Although the gang of six talked interminably, no Republicans were willing to deal.
Proposed piecemeal, the cost-control measures already contained in the President’s proposal would command little public or interest-group support. These measures would command little enthusiasm from a Congress freed from the fiscal constraints required to pass a comprehensive bill that simultaneously provides critical benefits to millions of people.
The Post seems oblivious to the fact that defeat of the President’s comprehensive reform would damage any future cost-control effort. Interest groups that oppose specific measures–certainly including the “Cadillac tax” –would cite this defeat in discouraging politicians from supporting similar efforts. They would cite the success of crudely demagogic “death panel” rhetoric to deter serious measures to improve the quality and economy of Medicare services.
Progressive politicians desperate to help millions of uninsured people would learn from this episode that the smart move is to propose a politically attractive package of benefits without offsetting spending reductions or taxes to pay for it. I would hardly blame them.
Then there is the third reason. The Post writes: “We think that it is not asking too much, given the dire fiscal straits, for Washington to show that it can swallow distasteful medicine while, and not after, it passes out the candy.”
No candy is being distributed here. The bill whose survival is at stake is not some pork-barrel agriculture or weapons bill. After decades of failure, this bill would provide critical protection for 50 million uninsured people. It would help millions of others facing medical bankruptcy because they are underinsured or because they have serious illnesses leading them to exceed lifetime insurance caps that would be immediately ended under the President’s proposal.
This very morning, our local Catholic church presented an appeal from a family whose infant son was diagnosed with Hemophagocytic Lymphohistiocytosis, a rare and deadly disease. As the costs of his care approach $1 million, the family has established a website appealing for help. They have no plan B. There is no plan B for states, either, which desperately need this bill to avoid even more dire fiscal difficulties than are projected for the federal government.
The President has spent the past year, and has risked much of his presidency, to address these critical needs. After this bill is passed, he and the Congress should pursue further serious cost-containment efforts. The current bill provides the best platform to do this.
There is a moral urgency to passing this bill. The President, House and Senate leaders might have done more to cut costs if they had even secured one or two moderate Republican votes. They had to cut some messy deals to get this done. There were good reasons to do so. Against heavy odds and several decades of failed efforts, President Obama and his allies are close to getting this done. By fetishing a single imperfect aspect of the President’s proposal, the Post mischaracterizes the policy dilemma. The Post also misses the magnitude of what is at stake.
By: Harold Pollack- the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment-The New Republic, March 7, 2010
“NO” IS NOT A PROCESS
“NO” IS NOT A PROCESS
The dust has yet to settle from last weeks debacle in the Massachusetts Senate election. I have been listening to the pundits who have incessantly harped on and dissected what they thought the election of Scott Brown actually meant for the rest of the country, and for Democrats in particular. The clamoring and jaw-jerking by these same pundits was relentless. They were way too eager, often tripping over themselves to get air time to declare an apocalypse for the Obama administration. Their summations declared Brown’s win as a complete repudiation of the administrations policies and thus, the direction in which these policies were leading the country. Others thought that Brown’s verbal opposition to the current national health reform legislation was the most important factor that led to his upset victory. To be fair, this last interpretation does carry with it a partial truth.
Just for the record, an exit poll conducted by a GOP pollster, Tony Fabrizio, showed that only 38% of the eight hundred participants said they were motivated by opposition to the President’s policies. On the other hand, 32% indicated that they were motivated by support for his policies and 27% indicated that Obama’s policies were not a factor in their voting at all. This means that 59% of the voters polled were either for or indifferent to the President’s policies when they cast their ballot. Furthermore, 53% of independents either supported or were indifferent to the President’s policies.
My take on the results of this Massachusetts election is that a message was indeed sent on that Tuesday night. All of the pundits seem to think that this message is targeted only towards Democrats That message is that people are frustrated, infuriated and exasperated. Why? Because Congress is Not doing its job, plain and simple. A recent CBS poll shows that the approval rating for Congress currently stands at 23% while that for the President remains at 55%. Neither of these numbers however should make anyone comfortable. As such, I believe that Republicans should be just as concerned about November as the Democrats. There is a whole lot of frustration out there and it is highly probable that it will be an equal opportunity un-employer come November.
Reforming health care goes hand in hand with getting the economy back on track. I would like to think of Congress as an institution that is honorable and works for the good of all the people. There is absolutely no reason why health reform should not have been passed to date. There have been all kinds of excuses, lies, obstructions and mis-representations at every turn of the process during this last year.
On the one hand, every Democrat wants to have everything under the sun incorporated into the final bill that the President will eventually sign. This includes the progressive members of the party who often do not or will not see from side to side because of blinders that only allow them to see the tip of their noses. Pay attention progressives….you cannot and will not get everything incorporated into a single package by days end! There will be no “all encompassing” health reform product…this is a project that will have to be massaged for many years to come. This project requires negotiation and cooperation. If you let this opportunity slip away, there will be no second chances. Reasonable people do not use an axe to remove a fly from their forehead. Do not become an instrument for those who say “NO”.
On the other hand, there are my Republican friends who want to say “NO” to anything and everything. First we have those who are livid about the “costs” of any reform package, never mind that this was never a consideration during the previous administration. If it had been, we wouldn’t be in the current mess we are in today. Remember the prescription drug program? If for some reason health reform is not passed this time around and you are worried about what it costs now, what do you think the costs will be when it finally gets back on the radar screen down the road…. and I’m talking somewhere around 2059.
Then there are those who are baffled and dismayed by how the Democrats handled the “process”. They rise to their pontifical perches to berate the Democrats for excluding them from the discussions and debates. They tell anyone who will listen that they have been shut out of the process and that there has been no transparency in any of the multiple committees, no bipartisanship, no good faith, none whatsoever. They were not allowed to offer any amendments to any of the bills at any stage of the “process” and that they were placed under unreasonable “time lines” for completion of a final bill.
As far as I have been able to ascertain, Republicans should be the last to complain about process, bipartisanship, transparency, and good faith. I did a little checking on Republican participation in the various committees leading up to the final passage of the Senate and House health reform bills. On the Senate side, the HELP committee adopted 159 amendments offered by Republicans. On the House side, 16 Republican amendments were adopted during procedures of the Energy and Commerce Committee. In the Education and Labor Committee, 6 of the 17 Republican amendments were adopted by the committee. Finally in the Ways and Means Committee markup, 38 of the Republican sponsored amendments were rejected by the committee.
I think that it is worth noting that during the 111th Congress, Republicans have attempted to filibuster a minimum of 30 times. This has been a part of the “strategy”, a strategy straight from the “obstructionist playbook” offered to Republican colleagues by Sen Judd Gregg in a memo on parliamentary strategy that republicans could use to offer amendments and extend debate on particular resolutions. In efforts to thwart the process, Republicans often offered “technical amendments”, knowing firsthand that they were not significant or relevant to the issues at hand. They were offered only for “strategic” purposes. As expected, these nuisance and frivolous amendments were rejected. Yet these same senators want us to think that they were victimized and that the “process” wasn’t fair or bipartisan….that these amendments were being offered in good faith. Give me a fricking break! By design, you corrupted the process and got what you wanted…an opportunity to cry foul and afford yourselves with another easy distraction to take the focus away from the issues.
It seems to me that the Republican idea of bipartisanship is absolute concession to their ideology, no more, no less. Everything outside the reaches of this ideology falls into the category of “no”. There is no real intention to participate, only to be in a position to say no after no after no. If you continue to chose this route, I remind you that “NO” is not a process. There are consequences for “no”.
With the prevailing winds now blowing within the Washington beltway, it is no wonder that there is so much frustration outside the beltway. Congress, do your job! If you continue your childish games, come November, there will be many “Scott Brown’s” on both sides of the aisle.
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